Long-Term Stress and the Functional State of the Liver in Children Affected by the War in Ukraine

Abstract

Background and Aims: Stressful situations and sudden disturbances in the diet and nature of nutrition in children can lead to the development of intrahepatic cholestasis, which is of a functional nature. Aims: to identify and analyze the condition of the liver in children after prolonged stress and malnutrition as a result of the war in Ukraine. Methods: 60 children aged 5 to 11 years, who were in the occupied territories of Ukraine for 1 to 5 months and had serious eating disorders and post-traumatic stress disorder, were examined with abdominal ultrasound and liver function tests. Results: All children complained of constant, low-intensity nausea not associated with food intake, and pain in the right hypochondrium, worsening after physical activity. On palpation, only 15 (25%) had moderate hepatomegaly. Ultrasound of the abdominal cavity revealed in 15 children (25%) corresponding changes in the liver parenchyma (increased echogenicity, attenuation of the liver echo), thickening of the bile ducts (18 children (30%), stagnant contents (suspension/sludge) of the gallbladder in 25 (42%) patients. However, almost all children (58 (96.7%)) had impaired liver function tests: a disproportionate increase in alkaline phosphatase (5–8 times) and gamma-glutamine transpeptidase (5–8 times) relative to a slight increase (1.5–2 times) alanine aminotransferase and direct bilirubin. (2-3 times). After ymptomatic treatment for three months, there was a positive trend in all children. We regarded these changes as hepatocellular cholestasis of a functional nature. Conclusions: Stress and severe nutritional disorders in children lead to the development of intrahepatic cholestasis of a functional nature and require dynamic monitoring and timely correction.